Counseling African Americans to Control Hypertension (CAATCH): Cluster Randomized Clinical Trial Main Effects
Background—Data is limited on implementation of evidence-based multilevel interventions targeted at BP control in hypertensive African Americans who receive care in low-resource primary care practices.
Methods and Results—Counseling African Americans to Control Hypertension (CAATCH) is a cluster-randomized clinical trial in which 30 Community Health Centers (CHCs) were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, while physicians attended monthly hypertension case rounds, and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines respectively. The primary outcome was BP control and secondary outcomes were mean changes in systolic and diastolic BP at 12 months, assessed with an automated BP device. 1059 patients (mean age 56 years; 28% men, 59% obese and 36% with diabetes) were enrolled. The BP control rate was similar in both groups (IC= 49.3% vs. UC=44.5%, OR=1.21; 95% CI, 0.90-1.63; p=0.21). In pre-specified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes (IC=54.0% vs. UC=44.7%, OR=1.45; CI, 1.02-2.06); and small-sized CHCs (IC=51.1% vs. UC=39.6%, OR=1.45; CI, 1.04-2.45).
Conclusions—A practice-based multicomponent intervention was no better than usual care in improving BP control among hypertensive African Americans. Future research on implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population.
Clinical Trial Registration Information—http://clinicaltrials.gov. Identifier: NCT00233220.
- practice-based trial
- hypertension, high blood pressure
- behavior modification
- high-risk populations
- health disparities
- clinical trial
- Received October 19, 2013.
- Revision received January 13, 2014.
- Accepted February 7, 2014.